13. What are the risks associated with a FESS (functional endoscopic sinus surgery) procedure?
sinus-faq13-drmcgraw
Becky L McGraw-Wall, M.D. Houston, TX
Although sinus surgery is a fairly common, safe surgical procedure, it is not without surgical risk. The most frequent complications include the potential for postoperative bleeding and infection and the possibility of recurrent sinusitis. The other serious risks are rare, and are related to the sinus anatomy and its close proximity to the eyes and skull base. Injury to the eyes, the eye muscles which move the eye, and the optic nerve itself can occur. Bleeding into the back of the eye can occur, which can affect vision if not treated promptly. A spinal fluid leak can result if the bony skull base that separates the sinuses from the cranial cavity is fractured or opened during sinus surgery. In addition, it is possible to have an injury to the sensory nerve of the cheek when operating on the maxillary sinus.
sinus-faq13-drkingdom
Todd Kingdom, M.D. Denver, CO
Many potential risks are associated with sinus surgery. A careful review of these risks must be discussed with all patients considering sinus surgery. Surgeons typically group complications into two groups: 1) minor and 2) major complications. Minor complications typically do not lead to significant problems, are managed successfully, and are more common. The most common minor complications include bleeding from the nose and scar formation after surgery. Of course, an additional risk of sinus surgery is the potential failure to correct the symptoms or problems that the patient is experiencing. Both may require minor interventions to correct such as placement of packing materials in the nose to stop bleeding or minor office procedures to release scar formation. In some situations, post operative scar formation may lead to further surgeries to fully correct the problem. Sinus surgery can be associated with several major and even catastrophic complications. The proximity of the orbit (eye) and brain to the sinus cavities places these structures at risk during any surgical procedure of the sinuses. Visual change, visual loss, and brain injury have been described after sinus surgery. Cerebrospinal fluid leakage (trauma to the tissue layers surrounding the brain) may result from injury to the bone that separates the brain from the sinuses. If detected, this can be successfully repaired in 90-95% of cases. Overall, these major complications occur in less than 1% of all cases. Sinus surgery can be associated with several devastating complications; however, sound surgical technique and experience, advances in surgical equipment, and careful patient preparation have made these events very rare.
sinus-faq13-drhwang
Peter Hwang, M.D.
Associate Professor and Director
Stanford Sinus Center Stanford, CA
Because of the intricate anatomy of the sinuses, sinus surgery does carry a small risk of injury to adjacent structures. This includes possible injury to the eyes and to the lining of the brain, called the dura. A tear of the dura may cause brain fluid to leak into the nose, requiring additional surgery to correct it. There is also a small risk of bleeding after surgery, as well as associated risks of anesthesia. Fortunately, complications from sinus surgery are rare. You should discuss the risks of sinus surgery completely with your surgeon before you decide to proceed.
sinus-faq13-drferguson
Berrylin J. Ferguson, M.D. Pittsburgh, PA The risks associated with endoscopic sinus surgery in skilled hands are less than with non-endoscopic sinus surgery because of the improved visualization provided with the telescopes.
With the exception of discomfort to the cheek, all the complications discussed in the preceding question apply to FESS.
